Stanford Facial Nerve Center
Botulinum toxin (Botox™) and Hyaluronic Acid Filler for Facial Paralysis or Synkinesis
Hyaluronic acid (HA) fillers are used for temporary volume augmentation of different areas of the face. Their use in the setting of facial paralysis is not FDA approved and is considered cosmetic. However, hyaluronic acid fillers can improve some of the symptoms of facial paralysis by improving the symmetry of the cheeks, lips, and other areas of the face. Likewise, botulinum toxin is helpful in treating unwanted facial movement in synkinesis. In the Video, a patient of Dr. Pepper’s discusses her experience with botulinum toxin and filler use for facial weakness and synkinesis.
How long do these treatments last?
In general, botulinum toxin treatments last for three months. Filler lasts between six months to two years, depending on the type, amount, and location of the filler injection.
Brow lift for facial paralysis or synkinesis
Facial paralysis can result in drooping of the eyebrow. This can be severe enough in some cases to cause obstruction of vision in that eye. To treat this visual obstruction and improve the symmetry of the eyebrows, a brow lift can be performed. The most common means of lifting the brow in facial paralysis are either a direct brow lift, where skin is removed just above the eyebrow, or an endoscopic brow lift, where the brow is elevated using an endoscope. Small incisions placed in the hair-bearing scalp. An endoscopic browlift is particularly helpful for the treatment of synkinesis, if the abnormal facial movement affects the eyebrow region. A patient who had a facelift performed by Dr. Pepper is shown in Figure 1 and Figure 2. Brow lifts take about 1.5 – 2 hours to complete and usually require general anesthesia, depending on the technique chosen. For recovery, we recommend two weeks off of work. Expect that swelling and any bruising will resolve in 2 or 3 weeks.
Facelift for facial paralysis
Some patients with facial weakness may benefit from a facelift (rhytidectomy) on the side of their facial paralysis. The goal of this facelift, as in all facelifts, is the elevation of redundant and drooping soft tissue near the jawline and neckline.
This is not a facial reanimation surgery, but can improve resting symmetry and have a pleasing effect on the appearance of the face.
Facelifts take about 4 hours to complete, require general anesthesia, and are usually performed as an outpatient.
For recovery, we recommend two weeks off of work. Expect that swelling and any bruising will resolve in 2 or 3 weeks.